Associated Factors on Cytomegalovirus Reactivation in Patients with COVID-19 in the Intensive Care Unit.

Background: Critically ill patients in intensive care units (ICUs) are susceptible to cytomegalovirus (CMV) reactivation. Previous studies have identified an association between CMV reactivation and increased mortality, length of ICU stay, and duration of mechanical ventilation (MV). Methods: The study compared severe COVID-19 patients who received antiviral therapy (ganciclovir) for CMV reactivation (n=39) with a control group of patients without reactivation (n=39). Results: The reactivation group exhibited higher mortality rates (n=28, 71.8%) than the control group (n=15, 38.5%). Duration of steroid treatment, prolonged MV, and lower hemoglobin levels were identified as factors associated with CMV reactivation. The optimal cut-off value of hemoglobin was found to be ≤ 9.8 g/dL (p<0.001, AUC: 0.708, sensitivity: 56.41, specificity: 84.62). Furthermore, significantly higher ALT (alanine aminotransferase) levels were observed in the reactivation group (p < 0.001), and an association was found between elevated ALT and reactivation (AUC: 0.721). Within the reactivation group, the baseline CMV DNA levels were higher in non-survivors (n=28) than in survivors (n=11), although this difference was not statistically significant. A downward trend in CMV DNA levels was observed during follow-up in both survivors and non-survivors, eventually reaching undetectable levels. Conclusions: In critically ill patients, CMV reactivation was associated with prolonged ICU stay, mechanical ventilation, and steroid therapy. Lower hemoglobin and elevated ALT levels may serve as useful clinical indicators for CMV reactivation.